Visual impairment in combined pathology: multiple sclerosis and pituitary adenoma

Abstract

Purpose To study the changes of visual function in patients with combined pathology: multiple sclerosis and pituitary adenoma. Methods Four females from 18 to 41 years old were examined.They complained of decrement of visual acuity, pain with eye movement. We identified decrease in visual acuity from 0.01 to 0.1, visual field central defect.To exclude organic pathology, the patient was sent for MRI of the brain, confirmed the diagnosis: MS and pituitary adenoma. For identify the root cause of reduced visual acuity, patients were examined by Cirrus HD‐OCT; Humphrey HFA II‐750i; Microperimetry on MP‐1, MRI of the brain and orbits. Results 144 patients were examined in the S. Fyodorov “Eye Microsurgery” Complex, Moscow, 4 of them were diagnosed and confirmed a combined pathology:MS and pituitary adenoma. According ophthalmoscopy in three patients was marked optic disk hyperemia and swelling of the disc margin, one patient – temporal optic disk pallor. According microperimetry we received a decrease in overall photosensitivity from 8.3 to 11 dB. OCT: in 3 patients revealed a slight an increase average retinal nerve fiber layer thickness (A RNFL) from 110 to 113 μm. In 1 patient revealed a decrease A RNFL thickness to 76 μm. To confirm demyelinating cause of optic neuritis was scheduled MRI of orbits. In two patients were found nidus of demyelination in the optic nerve. Hormonal activity of pituitary microadenomas in the blood serum: cortisol from 350 to 400 mME/l, prolactin from 190 to 315 nmol/l. Conclusions Visual impairment caused by demyelinating process that is confirmed by special methods of examination. Identified pituitary microadenomas is hormone‐inactive tumor, therefore they do not affect the clinical course of MS. Combined pathology requires a change in tactics of patient's management with the participation of the endocrinologist and neurosurgeon.